HEALTH: Forget Zika – I’m More Worried About Dengue Fever

Zika

February 2016 wasn’t the ideal time to be off to South America for seven months. The papers were full of scare stories about the dreaded Zika virus, and friends seemed surprised I was still going ahead with my trip. But with my flight already booked, what could I do?

As soon as I arrived at the airport in the Paraguayan capital Asunción, I was relieved to see that the authorities were taking the threat very seriously, spraying the plane with disinfectant to kill any stow-away mosquitoes. In Santa María de Fe, a small town in Misiones where I would be working as a volunteer English teacher for the next few months, my host family had helpfully pinned up a flyer on my wardrobe, warning of the dangers of mosquito-borne diseases and urging people to use repellent and a mosquito net.

But here in Paraguay, the fear was not so much of Zika as of dengue fever. Although there had been some cases of Zika in Paraguay since the virus was first confirmed here last November, they had been mainly limited to towns bordering Brazil and so far, the virus had not spread across the rest of the country as predicted. Indeed, Zika was barely mentioned here, unlike dengue fever, a frequent topic of conversation.

“Aedes aegypti, dengue is characterised by flu-like symptoms, with high fever, pain behind the eyes, severe joint and muscle pain, nausea and rashes.” Photo (c) Ministro de Salud Argentina 2016

Transmitted by the same mosquito, Aedes aegypti, dengue is characterised by flu-like symptoms, with high fever, pain behind the eyes, severe joint and muscle pain, nausea and rashes. While three quarters of those infected by the Zika virus do not develop symptoms, most infected by dengue do, and their symptoms are generally more severe. Since 2013, when Paraguay saw 130,000 confirmed cases of the dengue fever virus, the condition has seemed to be under control, with Paraguay even being commended by the World Health Organisation for its work in containing it.

However, following high temperatures and severe flooding over Christmas, dengue fever is again on the rise, and both Paraguay and neighbouring Argentina have declared an epidemic. This is especially worrying for people who have already had the condition, since reinfection by a different strain of the virus is more likely to lead to severe haemorrhagic dengue, which can be fatal.

With the dangers in mind, I was determined to avoid being bitten, yet this was easier said than done. Firstly, my mosquito net turned out to be a waste of space. Single beds are larger in Paraguay than in the UK, and I couldn’t even tuck the net in around my mattress, let alone prevent it from touching my legs. Paraguayans rarely use nets, preferring to sleep under a fan.

Settling for this alternative, my first night was a sleepless one – with only one speed setting, my ceiling fan made it feel and sound like there was a gale blowing in my room. I subsequently ended up using just a plug-in repellent, much to the bewilderment of my Paraguayan family who couldn’t understand how I could possibly manage to sleep in such a hot room with no fan.

“My bites appeared during the day, when the dengue-carrying mosquitoes are active.” (NOTE: Not photo of author). Photo (c) Web Consultas 2015

I soon worked out that most of my bites appeared during the day, when the dengue-carrying mosquitoes are active. In the institute where I teach, located in a red zone for dengue, I soon spotted an Aedes aegypti mosquito with its tell-tale black and white striped legs and, despite frequent applications of repellent, a fine collection of bites appeared over my whole body, including dozens on my lower legs and feet, which made wearing shoes very uncomfortable.

Most of my Paraguayan neighbours tell me they don’t use repellent, despite warnings and flyers around the town. The repellent sold here is weak and rather expensive for the average family. In general, most people here are so used to mosquitoes that they no longer seem to notice when they are bitten, whereas I suffer from every bite!

This doesn’t mean, however, that precautions are not being taken. Shortly after I arrived, lessons were cancelled for a day for the building to be fumigated, and recently my lessons were disturbed by the sound of the grass being cut just behind the outdoor classroom (quincho) where I was teaching.

“the Paraguayan government has passed a new law allowing people who fail to keep their land free from rubbish and weeds to be fined and imprisoned for up to five years.” Photo (c) FNC Static Global 2013

As part of its battle against mosquitoes and their breeding grounds, the Paraguayan government has passed a new law allowing people who fail to keep their land free from rubbish and weeds to be fined and imprisoned for up to five years.

While this may seem draconian, everyone I meet seems happy to go along with it, especially those worried about reinfection.

As summer turns to autumn and the weather turns cooler, we are finally seeing fewer mosquitoes. Even dengue is rarely mentioned now. But the fear hasn’t gone away completely. Like our neighbours in Brazil battling Zika we continue to take what precautions we can to avoid being bitten by mosquitoes and contracting the diseases they carry.